Association between post-vaccination adverse events and subsequent COVID-19 booster uptake in the Netherlands.

INTRODUCTION: This study aimed to assess whether the occurrence, severity, and duration of AE following COVID-19 booster vaccination were associated with subsequent booster uptake during the 2022-2024 autumn booster campaigns in the Netherlands. METHODS: We included participants from the Vaccine Study COVID-19 (VASCO), an ongoing prospective cohort study, who were eligible for booster vaccination in 2022-2024. Participants completed a questionnaire on AE one month after booster vaccination. Logistic regression was performed to assess the association between the occurrence, severity, and duration of local and systemic AE, and revaccination during the subsequent year. We adjusted for demographics and prior SARS-CoV-2 infection. RESULTS: In 2022 and 2023, 11,010 and 14,824 participants were vaccinated and completed the AE questionnaire. Of these, 73.7% and 87.0% were revaccinated in subsequent years. The occurrence of systemic AE in 2022 was associated with a lower odds of revaccination in 2023 (OR: 0.84 [95%CI, 0.76-0.93]). The likelihood of revaccination declined with increasing severity- moderate (0.79 [0.66-0.94]) and severe AE (0.45 [0.34-0.60]) - and longer duration (>5 days: 0.72 [0.54-0.95]) of systemic AE. Also, severe local AE (0.38 [0.23-0.60]) and seeking medical care for AE (0.50 [0.34-0.73]) were associated with reduced vaccination uptake. Similar associations were observed for revaccination in 2024. CONCLUSION: This study found a lower likelihood of subsequent COVID-19 booster uptake after experiencing systemic AE, particularly when severe or prolonged, or when experiencing a severe local AE. These findings underscore the need to address experienced AE in communication strategies, as this may influence the success of vaccination campaigns.